Due to the high pressures in the aorta, blood enters the media at the point of the tear. Arch Surg. Blunt trauma to a patient is a more common cause of a vascular intimal flap than penetrating trauma. The 49 cases reported in the literature have been summarized, and we have added reports of nine new cases. to download free article PDFs,
It is easily recognized as a linear echo of varying thickness. With an intact media or media and adventitia, there will not... Over 10 million scientific documents at your fingertips. Shop Movement of the flap parallel to the aortic wall is generally seen when the false lumen is thrombosed or when there is a retrograde extension of the dissection either from the arch or from the proximal descending aorta to the ascending aorta. © 2020 American Medical Association. Sémiologie échographique thoracique: à propos d’un cas. On arteriography, it is recognized by a bandlike shadow in the column of dye and diminution in the density of dye distal to the band, although complete occlusion may be seen also. Laisser un commentaire Annuler la réponse. © 2020 American Medical Association. Privacy Policy| Contact The lesion requires prompt surgical correction by either resection of the artery or intimectomy with or without a vein patch. Our website uses cookies to enhance your experience. Navigation des articles. Privacy Policy Customize your JAMA Network experience by selecting one or more topics from the list below. McGraw-Hill, New York, pp 941–970, Frykberg ER, Vines FS, Alexander RH (1989) The natural history of clinically occult arterial injuries: A prospective evaluation. Part of Springer Nature. Deceleration-type trauma or a side impact in a motor vehicle crash can lead to disruption of the intima alone or intima and media of the descending thoracic aorta just distal to the ligamentum arteriosum. Separating the false lumen from the true lumen is a layer of intimal tissue known as the intimal flap. | 1971;102(6):552–555. Accessibility Statement. Similarly meticulous incremental views of the aorta should be obtained using a multiplane transducer, imaging the entire segment from short axis to long axis so that all portions are seen. Separating the false lumen from the true lumen is a layer of intimal tissue. It is usually thin <2 mm in acute dissections and thick >4 mm due to neo intima formation on the false lumen side, in chronic dissections. The movement of the intimal flap depends on the extent of separation and the blood flow dynamics in the true. Figure 4.7. The force of the blood entering the media causes the tear to extend. Pour la Jugulaire Interne , l’approche oblique serait la plus « secure » ! Get free access to newly published articles. The vast majority of aortic dissections originate with an intimal tear in either the ascending aorta (65%), the aortic arch (10%), or just distal to the ligamentum arteriosum in the descending thoracic aorta (20%). This service is more advanced with JavaScript available, An intimal flap in an artery can also be described as an intraluminal flap or wall defect in an artery. Terms of Use| Il flap intimale è lo scollamento della lamina elastica della tonaca media arteriosa. | doi:10.1001/archsurg.1971.01350060016006. In dissecting aneurysm with a small intimal avulsion and severely enlarged false lumen11, the dissection may be missed and mistaken for an aneurysm alone. The intimal flap may occur in any artery after severe blunt trauma with or without fracture of bone and occasionally in high-velocity gunshot wounds. | TEE images of an aortic dissection demonstrating the usefulness of multiple views. Arrow head pointing to the communication demonstrated by color Doppler. From the Department of Surgery, University of Southern California School of Medicine, and Los Angeles County-University of Southern California Medical Center, Los Angeles. Mise en garde médicale modifier - modifier le code - voir Wikidata (aide) La dissection aortique est une affection rare et grave caractérisée par l'irruption de sang à l'intérieur de la paroi de l' aorte . Hare RR, Gaspar MR. F = false lumen, T = true lumen. Not logged in However, the tear may not be obvious in an aorta with atherosclerosis. Elle constitue une déchirure ou porte d'entrée, par laquelle le sang sous pression entre et décolle les feuillets superposés qui constituent la paroi élastique de l'aorte. 37.187.30.118. Resources, Is it a true dissection or intramural hematoma or penetrating ulcer, Reduction Of Dpdt And Treatment Of Hypertension. It should be suspected in any patient with a history of blunt trauma who has signs of arterial insufficiency. All Rights Reserved. The intima is the innermost layer of an artery (or vein) and is composed of endothelium (the cells lining the lumen), a subendothelial layer of connective tissue, and an elastica interna. Surgery 109:85–96, Frykberg ER, Schinco MA (2008) Peripheral vascular injury. A tear in the intima with out avulsion from the underlying layers will be seen as abrupt discontinuity of the surface. A piece of intima still attached to the media may result and will project into the lumen of the artery as an intimal flap. An intimal flap in an artery can also be described as an intraluminal flap or wall defect in an artery The wall of an artery is composed of a tunica intima, tunica media, and a tunica adventitia. Intimal Flap - Aortic Dissection - RR School Of Nursing. Advertise When there is uncertainty as to which is the true and which is the false lumen, intimal flap mobility as assessed by M-mode echo can be helpful. Write For Us Limited systolic mobility of the intimal flap generally indicates that the false lumen is more of a blind pouch or column with no reentrant tear or thrombosis of the false lumen distally. About Parallel movement may also be seen with reverberation artifacts. | © 2020 Springer Nature Switzerland AG. and false lumen and thrombus formation. It is usually thin 2 mm in acute dissections and thick >4 mm due to neo intima formation on the false lumen side, in chronic dissections. The Intimal Flap. This is because the major flow is still in the true lumen. The intimal flap may occur in any artery after severe blunt trauma with or without fracture of bone and occasionally in high-velocity gunshot wounds.